Patient Perceptions of Quality of Shared Decision-Making for Lung Cancer Screening in Telehealth vs In-Person...

Guidelines recommend shared decision-making (SDM) about lung cancer screening (LCS) to ensure that choices about LCS are informed and consistent with patient goals. Telehealth may increase access to SDM, but its quality compared with in-person delivery remains unclear.

How does SDM method (in-person or telehealth) affect patients' perceptions of quality of SDM for LCS, associated best practices, and outcomes?

We administered a mail survey to patients from 7 Veterans Affairs hospitals who underwent SDM for LCS within the prior month. Surveys assessed demographics, SDM method (primary exposure), occurrence of best practices for LCS counseling and SDM (provision of educational materials, alignment with decision-making preferences, and smoking cessation counseling), and decision-making outcomes (perceived quality, provider empathy, satisfaction, LCS decisions). Adherence to initial LCS imaging was determined from the Corporate Data Warehouse. Our primary outcome was perceived SDM quality measured using the CollaboRATE score (the top score of 27 indicates high quality).

Of 1,033 patients surveyed, 320 patients responded (31.0%); 121 patients were excluded because they did not remember the LCS conversation or were missing primary exposure or outcome data. LCS conversations were evenly split between in-person (101 of 199) and telehealth (98 of 199) methods. Overall, 34.2% of patients (68 of 199) reported high-quality SDM, with no significant difference by method (adjusted OR, 0.76 [95% CI, 0.398-1.448] for telehealth vs in person). Educational materials were supplied significantly more often during in-person than telehealth discussions (40.6% vs 22.6%; P = .008). Comparing in-person with telehealth interactions, we found no significant difference in secondary outcomes including decision satisfaction, perceived provider empathy, alignment of decision-making with the patient's preferred style, provision of smoking cessation counseling to those currently smoking, LCS decisions, or adherence to initial LCS scan.

Our results show that outcomes were similar regardless of method of LCS SDM conversations. Telehealth for LCS SDM may be a useful option to improve equity and access, potentially reducing barriers to LCS uptake.